PROJECT SUMMARY This proposal features a comprehensive pre-doctoral program of training, mentorship, and research activities that will provide me with the support, knowledge, and skills necessary to advance my career goals of attaining a tenure-track faculty position at a research intensive academic medical center, and becoming an independent research scientist as well as a leader in the field of pain communication. Training activities will be completed as a doctoral student in the Health Behavior Track of the Joint Doctoral Program in Public Health at the University of California San Diego (UCSD) and San Diego State University (SDSU). The overall research objective is to build from my previous background in pain communication to better understand how communication practices influence pain outcomes in the physical therapy management of adults with chronic spine pain. This will be accomplished by conducting a mixed methods, longitudinal study of the relationship between communication practices (empathic communication and up front agenda setting), patient-provider therapeutic alliance, and clinical outcomes (pain intensity and interference) in patients referred to physical therapy for the management of chronic spine pain. A comprehensive training plan that includes didactic coursework and practical research experience will allow me to gain advanced knowledge and skills in the emerging field of pain communication, including (1) clinical research and practice by working directly with physical therapists and patients with chronic spine pain, (2) qualitative research in the field of communication to include mixed-methods approaches in the evaluation of patient outcomes, (3) professional networking in both communication and pain management research, (4) leadership and management by mentoring graduate and undergraduate student research experiences, and (5) study design and analysis, project management, and dissemination of research findings.